食管癌新辅助化放疗后残余病灶患者手术延迟时间过长的影响

Prolonged Time to Surgery in Patients with Residual Disease After Neoadjuvant Chemoradiotherapy for Esophageal Cancer

ANNALS OF SURGERY

影响因子:6.4

分区:医学1区 Top / 外科1区

发表日期:2024 Aug 13

作者: Hidde C G Overtoom, Ben M Eyck, Berend J van der Wilk, Bo J Noordman, Pieter C van der Sluis, Bas P L Wijnhoven, J Jan B van Lanschot, Sjoerd M Lagarde,

DOI: 10.1097/SLA.0000000000006488

摘要

本研究旨在探讨新辅助化放疗后，具有组织学证实残余病灶的局部晚期食管癌患者手术延迟时间过长是否对生存、病理结果或术后并发症有负面影响。传统上，手术的标准时间（TTS）为完成nCRT后6至8周。近年来，延长TTS的效果受到关注，关于生存率和手术并发症的研究结果存在分歧。假设在完成nCRT后6周仍有残余病灶的患者中，延长TTS可能与生存预后更差及并发症风险增加相关。研究对象为在nCRT后6周内经活检确认残余病灶并接受手术的患者，根据手术间隔（TTS>12周与TTS≤12周）进行分类。本研究的主要终点为总生存期，次要终点包括无病生存期、手术结果、病理结果及术后并发症。采用多变量Cox回归分析比较生存差异，逻辑回归分析其他结局，调整的混杂因素包括年龄、cT、cN、Charlson合并症指数、nCRT期间体重变化及完成nCRT后WHO性能评分。共纳入40例TTS>12周患者和127例TTS≤12周患者。结果显示，TTS>12周组的总生存期（调整后风险比（aHR）0.46，95%CI 0.24-0.90）及无病生存期（aHR 0.48，95%CI 0.24-0.94）优于TTS≤12周组，但同时其术后呼吸系统并发症发生率更高（调整后比值比（aOR）3.66，95%CI 1.52-9.59）。其他结局在两组间无显著差异。结论认为，对于在nCRT后组织学证实残余病灶的食管癌患者，延长手术时间（>12周）对总生存和无病生存无负面影响，但可能增加术后呼吸系统并发症的风险。

Abstract

To investigate whether prolonged time to surgery negatively affects survival, pathological outcome or postoperative complications in patients with histologically proven residual disease after neoadjuvant chemoradiotherapy for locally advanced esophageal cancer.Historically, the standard time to surgery (TTS) has been six to eight weeks after completion of nCRT. The effect of prolonged TTS is gaining interest, with contradicting results on survival and surgical morbidity. It can be hypothesized that, in patients with residual disease six weeks after completion of nCRT, prolonged TTS might be associated with worse survival and higher morbidity.Patients with locally advanced esophageal cancer who had biopsy-proven residual disease six weeks after nCRT and underwent surgery, were categorized according to interval to surgery (TTS>12w vs. TTS≤12w). Primary outcome of this study was overall survival. Secondary outcomes were disease-free survival, surgical outcomes, pathological outcomes, and postoperative complications. Multivariable Cox regression was used for comparing survival and logistic regression for other outcomes, adjusted for the confounders age, cT, cN, Charlson comorbidity index, weight loss during nCRT, and WHO performance score after completion of nCRT.Forty patients were included for TTS>12w and 127 for TTS≤12w. TTS>12w was associated with better overall survival (adjusted hazard ratio (aHR) 0.46, 95%CI 0.24-0.90), and disease-free survival (aHR 0.48, 95%CI 0.24-0.94), but also with more postoperative respiratory complications (aOR 3.66, 95%CI 1.52-9.59). Other outcomes were comparable between both groups.Prolonged TTS in patients with histologically proven residual disease after completion of nCRT for esophageal cancer did not have a negative effect on overall and disease-free survival, but patients did have a higher risk for postoperative respiratory complications.